Describe the women who have most influenced your life and the formation of your character.

I'm sure that the person, if I can tag my decision to a person who's been the role model for me, is a pediatric cardiologist, who I worked for in a very unambitious setting. I was a mother's helper for his kids for two summers. I actually didn't see a whole lot of him, because he was young in his career, and was at work all week, and on good weekends came home on Friday night or Saturday morning. So, I was primarily helping his wife.

I can't remember whether this was the summer I was 15 or 16, but I was watching his kids and reading a book about human genetics on the beach. I was just interested and that caught his eye. He asked, "Have you ever thought about being a doctor?" He didn't say, "Have you ever thought about being a nurse?" He said, "Have you ever thought about being a doctor?" And he offered me a couple of opportunities to watch cardiology procedures, and stayed interested in how I was doing at school, and what my thoughts about a career were. So, he was clearly the person who explicitly put it in my head.

I think, also psychologically, my mother's death when I was nine, had created a personal resonance for me between medicine and my own life. So, it took me much longer to get back to that and discover it.

I think that at some level, I wanted to understand why that happens to people, why young people die, why old people die, for that matter, and to the extent that I could, in a suitable way, intervene with people for whom it really wasn't time yet, as it was not time for my mother, at 36, to die. I wanted to be able to do that.

Do you consider yourself a feminist? Why or why not?

Absolutely. It means to me a celebration of high regard for the capabilities and special attributes of women, and appreciation of the special dynamics of groups of women together. It has changed for me, over time; I think it's become more personal. When I began college, I ran into NOW, the National Organization for Women. I joined NOW, and I was more of an extroverted political feminist.

To some extent, there was a bit of a paradox. At that time, I spent most of my social time with men. I sort of prided myself on having male friends, and, to a certain extent, I didn't particularly value friendships with women.

I don't mean to suggest for a minute that there's anything general about this. This is only my experience, and may reflect some unusual features. I went to a tiny, all-girls high school. So, just the opportunity to be around men was sort of novel for me, and I enjoyed the intellectual repartee and just the different feel of friendships with men.

However, the women's group in medical school that I joined was a very important home for me. As I have said before, not that I felt a bit oppressed in medical school, but it was queer to me that our experience as women medical students was often quite different than that of our male classmates.

I graduated from Stanford Medical School in 1977, and was part of the leading edge of a kind of catch-up group of women in medical school. My recollection is that my class was about 1/6 women. It was unusual, but not completely groundbreaking at the time. The women in my class were a very cohesive group, and we had formed a women's group early, that continued basically all the way through medical school. But I also remember feeling very supported and encouraged by the men in my class, who were, I think, excited to be part of a social transformation in medicine.

What would you most like to tell your daughter, son, the next generation about your hopes for women of the future? How would you advise a young woman to go about finding her own voice?

It's hard to be generic about what I advise because it's highly individualized. I am working in, what psychologists would call, a values clarification mode. I'm listening and asking young doctors, what is it that you're looking for? Where are you experiencing problems, and let's try and understand those problems.

I think part of my approach comes from the fact that I combine being relatively thick-skinned and fundamentally optimistic. So, I suspect there are times when someone was intending to give me a hard time, or it might have been perceived by someone else as being given a hard time, where I almost didn't notice it, and that's probably saved me some emotional wear and tear. There's another part of your question that is something I find myself talking about, that really has to do with tactical comportment in the workplace.

If you have a gripe in the workplace, and often we do, it helps to have, not just the gripe, but a couple of possible remedies. It helps with a lot of people - now, this is not across the board - but it helps with a lot of people, to use a calm, firm, and relatively directed interpersonal style. When I spend time with a young faculty member (it's almost always women) who is so upset and frustrated about something, or feeling so under-appreciated, that he or she, usually she, will come in here and cry. And I say, that's absolutely fine. You've chosen carefully. But this will probably not get you where you want to go with your boss.

For people starting out, this environment is very competitive and quite unfriendly. There's a strong sense that people need to prove themselves. When they've been around five years, or seven years, the usual timeframe for promotion to associate professor, if they've made that hurdle, then perhaps we'll deal with them. That environment is often very unpleasant for people, and maybe more unpleasant for women. Affiliation, camaraderie, and support are things that are important to women, not just in their personal lives, but in all aspects of their lives. This kind of environment can really grind people down, but that's how this environment is. As a long-term project, we should work on changing it. But if I'm talking to somebody who's a third-year assistant professor, it's definitely not going to change by the time she needs to have leapt the hurdle to associate.

So, there's a part of this process of saying, yes, it's no good, but that's how it is. Now, what are we going to do? And where are you going to get your support that works for you? And how, if you need to, as we often do, are you going to separate getting the support from making the objective academic progress that you need to make?

I often find myself doing that, and saying, anytime you're feeling bad, come and see me. And I'll look at your baby pictures, and we'll talk about how hard it is to do all this at once, and how you feel very unappreciated, and I'll help with some of those feelings. But the issue with your boss is that you've only been given a tenth of a secretary, and you're trying to get a grant out, and here's a problem that needs to get addressed.

How do you define success for yourself? How would you define success for the next generation?

For me, success is multi-faceted. I'm not sure I can really unify the facets conceptually. The opportunity to do work that's meaningful, that's helpful to other people, and that produces, either immediately or over time, some positive change. Those are all concepts that are important to me, when I think about success.

I think what's important to me, as well, is that I'm seen, by the people I work with, as constructive and generous and a person of integrity. And the way I've defined it, with a particular external dimension, the idea that someone who is doing those things is likely to be held in some regard in, at least, the local community in which they work.

What made you decide to pursue your occupation?

Well, part of this was just innocence. There are no doctors in my immediate family. I really had no idea of what the day-to-day realities of being a physician were, which is maybe a good thing. Now I'm going to sound like I'm answering the medical school admissions question, but I was very interested in science, I was good at math, but I also very much liked working with people, and discovered that through high school and college. Medicine seemed to be a nice combination. I was also making these decisions in the very early 70s, and the opportunity to do work that was meaningful and socially useful was important to me.

What challenges have you dealt with at work or at home due to your gender? What benefits?

I undertook a project here as part of an operation called the Chancellor's Advisory Committee on the Status of Women, which was exactly as the name suggests, a committee founded, I think, in the early 80s, to help the then-chancellor think fairly broadly about women on the UCSF campus. When I joined that committee, I was asked by the then-chair to look at faculty issues, and particularly make a snapshot of how faculty women were doing.

So, we did a couple of things. (This was as all of these kinds of projects are, a very collaborative project, and a staff member of mine worked really hard on it, as well as another faculty member and her assistant.) We took the organizational units on campus, mostly departments, but other kinds of organizational units as well, that had more than 20 people in them, and really looked at the distribution of women compared to the distribution of men, by the prestige of their appointments.

Here at this campus, there are actually five different kinds of series appointments that faculty can have, that range from very prestigious to adjunct and clinical. Some of the distinctions within the series have to do with free-floating prestige. Some of it also has to do with access to positions of structural influence. For example, two of the series don't confer membership in the academic senate. So, you can't vote as a member of the faculty. Department chairs and division chairs invariably come from the two most prestigious series.

So, if women and men are being appointed differently, they will have different access to those kinds of titled positions of influence. In fact, that's exactly what we found, that women appeared in most organizational units, kind of packed into the low prestige, flat trajectory appointments, and men were disproportionately represented in the good appointment series. I'm speaking, now, of the School of Medicine.

One of the things that the University has done, and I'll use the word intentionally, is to obfuscate the numbers by lumping all four schools together. And the School of Nursing is overwhelmingly female, and has women in all kinds of fancy series and high positions. So, the numbers presented in aggregate don't look as bad as they do when you start looking with a kind of finer grain at what's actually going on here. We actually were expecting to find this, and we also found, as have other people looking at the same question, that if you look at rank, the professors are men. Women are the infantry, the beginning, assistant professors, and clinical instructors. Some of that's a cohort effect. In fact, when we first presented these data, that's what everyone said, because that's where the faculty came from, the graduating medical school classes 10, 15, and 20 years ago.

But we then also looked at recent hires. What does the faculty look like who have been hired at entry level positions, within the past five years? Again, we found that the newly hired faculty, the women were adjunct and salaried clinical, and the men were in the tenure series and the in-residence series. So, in fact, for some departments it was clear that to bring about a change from 10 percent to 20 percent women in the more prestigious series, it was going to take, with current hiring rates, 200 years to right the imbalance.

We then did a salary equity study (this was a very conservative design) in which we took people in the academic senate series, and found that in the most prestigious series, we matched men and women by degree and the rough period in which they graduated with their professional degree. And we looked at the rate of promotion. We looked at people who'd all attained the rank of full professor.

We did the study in all four schools, but the problems were regularly most severe in the School of Medicine. In terms of career trajectory, men got where they were going faster than women. And, at each point along the way, we compared salaries of men and women at the same rank and step, who ultimately achieved the rank of full professor. Almost invariably, with a couple of exceptions, when we found matched pairs with discrepant salaries, the woman was disadvantaged. In general, the differences in annual salary weren't huge, but over the years, the disadvantage accumulates for the disadvantaged faculty member.

We wrote a little report, but the truth is, we didn't have to write much of a report. We mostly disseminated the data. We didn't have to attach a lot of rhetoric to it. I remember it was quite moving, actually, to show people the spreadsheets with women concentrated in the lower series and lower ranks. A number of times, women would look at that and say, it's not just me. Women who had, themselves, been experiencing this personally, who were unsuccessful or ineffective in this environment, would look at the data and say, there's a systematic problem.

A lot of departments, like the dean's office in the School of Medicine, became quite interested in the salary equity piece of this, and proposed doing a more comprehensive study of salaries by gender, at which point a number of departments corrected salaries. I got a salary correction. It hadn't been my intention, but suddenly, I got a chunk more in my monthly salary, because the chairs didn't want to be embarrassed by having the Dean point these out and say, fix that.

I think the salary issue has been largely fixed. In terms of women in positions of structural authority, we're still struggling. And that has to do, largely, with the appointment discrepancies between men and women, and those are complex. I don't mean to suggest that that is all about the university's saying, you can't be an assistant professor in residence, you must be an adjunct professor. The time when women are starting out academic careers, or clinical careers, for that matter, is a complex time for relatively young adults. People are typically just starting a family, or thinking about starting a family, and there's a lot of apprehension -- certainly, I had this -- about the balancing of family and work questions that we were talking about before. You can't work part-time and get the top three positions, or top series, in terms of prestige. Some women may make the choice: I'd like to have the flexibility to work part-time. There's also the possibility that women aren't mentored as effectively, or perhaps women starting out need to be supported differently, to take on the challenge of an in-resident or tenure track appointment.

What woman (living or dead) would you most like to have dinner with and why?

A couple of people come to mind. This is a hodgepodge, but I will start with my mother, because she was clearly a person who combined being very feminine, with no lace at all, but very much a woman who was intensely creative, and a powerful person in herself. As a child, she was my mother, so I didn't have the opportunity to understand that as an adult myself. And going in the other direction, I would love for her to see where I am, and to meet my children.

I am a huge fan of Sojourner Truth. She is someone who had no external advantages whatsoever, but was so clear in her sense of self that she could be powerful through persuasion, and through the most compelling, authentic rhetoric.

And to make it a triad, I would love to meet Hillary Clinton, for much more complicated and more prosaic reasons. I would love to talk with her about -- not the sordid aspects of her marriage, but the partnership -- and the word that is on the tip of my tongue, and I'll just say it is, competition. My husband is a very accomplished person, who is far better known than I am, which shouldn't be a problem, but human nature being what it is, I think, it's, for every couple, at least intermittently an issue, and sometimes more than that. And here are two people with a huge amount of drive. What have they talked about, and how have they managed?